Summary of recommendations for the prevention of viral hepatitis during travel

Abstract

Viral hepatitis is considered the most common travel-related, vaccine-preventable disease. All non-immune travellers to developing countries should consider vaccination with inactivated Hepatitis A (HA) virus vaccine and recombinant Hepatitis B (HB) virus vaccine. Inactivated HA and recombinant HB vaccines are safe, have few side effects and are effective in providing long-lasting protection. All monovalent HA and HB vaccines available for use within Canada are equally effective, and each can be used interchangeably. HA Ig (immune globulin) should be used to prevent HA only in those for whom active HA vaccines are contraindicated, in immunocompromised individuals who may not respond adequately to the active vaccines or in infants less than one year of age. All travellers should practise routine protective measures when abroad. HB virus carriers travelling to Hepatitis D virus-endemic countries should be particularly vigilant in avoiding high-risk activities such as skin piercing and unsafe sexual practices.

For travellers who have no or an incomplete history of HB vaccination, completion of a vaccination series is recommended before departure. One or two doses of HB vaccine administered before travel will still provide some protection and may initiate an HB vaccination series that can be completed after travel for those who cannot complete the full series before departureNote de bas de page 1.

For travellers presenting less than 21 days before departure, monovalent HA and HB vaccines should be administered separately, with completion of both immunization series after travelNote de bas de page 1.

Travellers already infected with Hepatitis C should receive HA and HB vaccines, if not already administered by their primary care providerNote de bas de page 1.

HA, HB and HAHB vaccines may be administered concomitantly with other vaccines at different injection sites using separate needles and syringesNote de bas de page 3.

Immune globulin

Vaccine is the preferred agent for pre-exposure prophylaxis for HA, therefore Ig should be used to prevent HA only in those for whom active HA vaccines are contraindicated, in immunocompromised individuals who may not respond adequately to the active vaccines or in infants under one year of ageNote de bas de page 1,Note de bas de page 3.

There are no immunoglobulin preparations or effective vaccines available in Canada that provide protection against Hepatitis C, D or E virusNote de bas de page 9,Footnote 14-18.

For individuals with a high likelihood of prior exposure (e.g. long-term residence in a highly endemic region or history of a compatible illness) and for whom cost is a significant issue, it may be reasonable to assume immunity. It may be cost-effective to test adults who grew up in developing countries or Canadian-born adults born before 1945 for anti-HA IgG prior to travel, if time permits, and immunize only those susceptibleNote de bas de page 3,Note de bas de page 19,Note de bas de page 20.

Routine serologic testing of previously immunized travellers for anti-HBs (antibody to Hepatitis B surface antigen) IgG is not necessary unless they are health care workers who have never had their anti-HBs titres verifiedNote de bas de page 3.

Personal protective measures

Adopt safer sexual practices and avoid any voluntary skin piercing, such as tattooing, acupuncture and body piercings, to minimize the possibility of exposure to HB, Hepatitis C or Hepatitis D.

Take great care when seeking medical or dental care requiring percutaneous or invasive procedures, to minimize the possibility of exposure to HB, Hepatitis C or Hepatitis DNote de bas de page 1,Note de bas de page 21.

HB carriers travelling to Hepatitis D-endemic countries should be particularly vigilant in avoiding high-risk activities such as skin piercing and unsafe sexual practicesNote de bas de page 1.

Human immunoglobulin does not provide protection against Hepatitis C, Hepatitis D or Hepatitis E, and currently no vaccines targeting these infections are available.

References

Footnote 1

Committee to Advise on Tropical Medicine and Travel. Statement on Hepatitis Vaccines for Travellers. Can Commun Dis Rep 2008;34(ACS-2):1-24.